June’s edition of Ambulance Today has a 2 page interview with Alan Murray, the man charged with dragging Welsh Ambulance Service out of the mire. Amongst all the usual back-slapping over how wonderful the staff are and what a difficult challenge they all face there was one poignant question and, for once, an answer that didn’t reiterate all the usual shit, propaganda from the commissariat.

Q: “Should the Ambulance Service’s performance be evaluated solely on response times or are there other indicators which give a clearer picture of overall service-delivery?“

A: “Response times are just a proxy for clinical effectiveness. We categorise too many of our 999 calls as potentially life-threatening and we need to focus much more attention on this area. I have an ethical objection to sending a five-ton vehicle at high speed through heavy traffic when we know the patient doesn’t need it. A clinically effective response to life-threatening emergencies is still a priority but we must find new and better ways of serving the rest of the 999 population. I would expect new measures to be more focused on good clinical outcomes and appropriate delivery of care and advice to people who don’t need an emergency ambulance. This is important to the patient but its also part of the Trust’s duty to its staff. If we expect EMS crews to respond immediately to 999 calls they have a right to know we won’t abuse that responsiveness.“

Bravo Mr Murray! How refreshing to hear a Chief Ambulance officer speaking out and stating what road crews have been banging on about for ages. Pity that none of his peers have got the balls to put their heads above the parapet.

“There is a plan to cut the number of ambulances and instead send us out individually in cars so we can assess whether an ambulance is really necessary.”

I’ve blogged previously how Nu-Labor’s target driven culture is leading to ambulance services being re-configured to meet the change in ‘A’ category response times due next April. Leaving the vulnerability issue aside, one of the primary results of this change in ambulance fleet composition is that solo responders will be left at scene with potentially very sick or injured people whilst waiting for Control to send them a back-up ambulance to convey the patient to hospital. From a management/Control point of view a patient with a solo on scene is no longer a priority no matter how sick or injured they may be. The response-time target will have been met (hopefully) and all the boxes ticked with the arrival of the solo. Diverting an ambulance only results in one less ‘resource’ available for the next target job. The are no points, prizes or cash available for using an ambulance to take a patient to hospital – clinical outcomes are not a priority.

We’re currently running a ‘scorecard’ on station for how long solos have had to wait before the cavalry arrived. The record at the moment is held by a trainee para (under-12 EMT) who was with a deteriorating patient for nearly an hour and a quarter. For myself, over just this last weekend, I can cite an 80 minutes wait with a patient having a suspected pelvic fracture and 55 minutes with a patient who’d collapsed in the middle of a car park, suffering a head injury, who subsequently fitted and who additionally had a confirmed tib + fib fracture. Luckily it wasn’t raining.

I admit to being a bit of a pessimist and reckon its only a matter of time before the Daily Mail (and other tabloids) start writing articles about how a patient died in front of a solo responder because the nearest ambulance was diverted away (probably to a patient with a cold that AMPDS had ‘triaged’ as a life threatening call – but more on that another time).

In 1976, the Khmer Rouge, under the leadership of Pol Pot and the mysterious “Angkar” (the secret revolutionary leadership), took control of Cambodia. As with so many other despot regimes the intellectuals and the bourgeoisie where either exterminated or ‘re-educated’. Independent thought was anathema; wealth and status were irrelevant; families where broken up and displaced to farms or building projects; all in pursuit of the utopian society. It is estimated that between one and two million Cambodians (20% of the population) and some foreigners were tortured and executed throughout the 3 years, 8 months and 20 days of Khmer Rouge rule.

__________________________

The June edition of Ambulance UK appeared on station recently. This is the “see how wonderful we are” magazine for the Ambulance Services Association. On page 154 there’s an article about Alan Murray’s crackdown leadership of Welsh Ambulance Service. I’ve blogged previously about the mess WAS has got into (see here, here and here). Apparently he’s decided that tactics that were good enough for Stalin, Mao and Pol Pot are good enough for him…

“[Alan Murray] is on record as saying the service will meet the 60% response time target during 2007/08 – staff are being “educated” that the targets are clinically meaningful and and not just another governmental hoop through which they must jump.” (the emphasis is mine but the quotes around educated are as printed in the magazine)

Those who refuse to believe will be shot – or worse, made to work for NHS Re-Direct.

I’m off again: it’s been far too long since I ‘headed out‘ and this time I’m travelling to Cambodia. Friends will know that ‘wanderlust‘ is in the Magwitch family blood – my ancestors, dating back to the 18th century, were all itinerant performers and I’ve been carted off around the world since early childhood. My last major trip was across Turkey, Syria and Jordan – a wonderful month and a half spent amongst some of the friendliest people I’ve ever met: particularly in Syria which I just adored – terrible food mind, despite being a neighbour to Lebanon whose cuisine is heaven. Sadly all my photos from that trip are on slide film and I still haven’t got around to converting them to digital.

Usually these adventures are just me, my camera and an itinerary that I make up as I go along, but this time it’s a little different. I met up with Lesley from Gecko Travel at the Daily Telegraph Adventure Show back in January and I’m booked on an organised trip which will also combine a photographic course under the guidance of renown freelance photographer Nathan Horton. Hopefully I’ll come back with a half-decent snap or two. I’ve got my Canon EOS 350 plus lenses and my PowerShot A20 already to go plus the most important thing you can ever take with you when travelling – a smile (never underestimate the power of a smile to a stranger).

Fingers crossed we’re not going to encounter any arrogant Brits along the way – unfortunately the most hideous people I’ve ever met when travelling are ignorant, load mouthed Brits who won’t attempt the language, the food or the culture and are generally obnoxious to everyone.

There’ll be no blogging for a few weeks. I hope to set up a small web-site with the photos (assuming there’s anything decent) upon my return.

The row over ambulance service meal breaks re-erupted last night after it emerged that two paramedics were sacked because they did not respond to a 999 call. The Yorkshire Ambulance Service (YAS) said yesterday that the paramedics were not on a meal break at the time, but this was refuted by the GMB union.

I confess that I know nothing more about this case than what has been reported, however, I can’t believe that two long serving ambulance staff suddenly take it into their heads to refuse to response to an emergency. The whole fiasco does not appear to be as clear cut as the BBC report would have us believe. According to the GMB rep “They said they could not respond because one of the men felt sick.”

My guess is this was a minor situation that got completely out of hand due to the overzealousness of some jumped-up local manager. He probably never bothered with a proper investigation but sacked the staff on the spot. Let’s not forget this is the service with the cowboy management, run by Simon Worthington, that issued termination notices to 400 staff 5 days before Christmas (see here) and then rescinded them 3 weeks later (see here).

Says everything you need to know about management competency in Yorkshire.

Full details are still awaited but it seems that EMTs will be no more.

My service is running it’s last EMT course. It’s also running it’s last paramedic courses for EMTs to convert to paramedics. In future, entry to paramedic level will be by university degree only.

From June 2007 the service will be recruiting a new grade of ‘lumpers and humpers‘ to be known as the Paramedic Assistant. They’ll just drive the ambulance and fetch and carry for the para; no patient care. We’ll be back to the good ol’ days when we had an ambulance driver and an attendant in the back.

It’s amazing how we just keep going round and round and round and round……

More 68 buses this morning: the first four jobs of the day were all category A ‘breathing difficulties’. That means a ‘response’ has to arrive at the location within 8 minutes.

As a prologue, let’s just remind ourselves of what a category A call is supposed to be. In a nutshell:

a condition (trauma or medical) which is immediately life-threatening within minutes of recognition and where rapid intervention and effective treatment by front-line ambulance staff will affect the outcome. [my emphasis]- From Review of Ambulance Performance Standards, July 1996

Or to put it another way – if we don’t get there ‘pronto‘ the patient is going to die.

Now that’s serious stuff so, in order to make sure we get it right, Control have the wonderful AMPDS system to triage our calls.

So, having hot-footed it to the addresses, what did I actually respond to this morning?

A patient with abdominal discomfort for 5 days. Seen by me on Monday night and his GP on Tuesday. No other symptoms but the ‘ache‘ around his stomach made him feel like he was having to breathe in harder than usual – he stayed at home.

A patient with a chest infection for 1 week. Seen by her own GP a few days ago and now on anti-biotics, but the carer thought she ‘seemed a bit worse today’ – she stayed at home too.

A young lady with side pain – seen at A&E last night; had a chest X-ray and all that stuff. Nothing too sinister but was discharged with a diagnosis of a chest infection and given antibiotics. She reckoned the pain was worse today and wanted to re-attend. Nothing life threatening but the crew popped her up the road as requested.

And finally, a lady having a panic attack. She’d calmed herself down by the time we arrived. We just did the usual checks; everything fine. She stayed at home as well.

There you have it – 4 immediately life-threatening calls – apparently. 3 stayed at home and 1 re-attended ‘just to be sure‘. That’s how ‘good’ AMPDS is (falls off chair laughing), yet on a serious note, ambulance services across the UK are reconfiguring their entire fleets just to make sure they can tick the Nu-Labour box for ‘A’ cat calls like these. What an absolute nonsense and a complete abandonment of patient care.

But hold on to your hats – it will get worse, much worse, next April when the goalposts are moved!